Pulmonary function tests
Dr. S.B.Deshpande
Professor of Physiology
Kanchanbari, Biratnagar,
Nepal
Pulmonary functions
1. Ventilation –
2. Perfusion- blood flow
3. Diffusion-exchange
4. Ventilation-Perfusion Relationships
5. Acid base balance- Blood Gases and pH-
transport/handling of gases
6. Mechanics of Breathing
7. Control of Ventilation
8. Exercise
9. Non respiratory functions
Pulmonary function tests
1-Ventilation – 5- Blood Gases and pH
• Forced Expiration, 6- Mechanics of Breathing
• Lung Volumes and Capacities • Lung Compliance
2-Diffusion- diffusion capacity • Airway Resistance
3-Blood Flow- Wedge pressure • Closing Volume
4-Ventilation-Perfusion Relationships 7- Control of Ventilation
• Topographical Distribution of Voluntary & reflex control,
• Ventilation and Perfusion Valsalva maneuver, Cheyne stokes
• Inequality of Ventilation & Biot’s breathing, Ondine curse
• Inequality of Ventilation-Perfusion 8- Exercise
Ratios 9- Non respiratory function tests
Pulmonary functions
Spirometry: Testing for static ventilation
Spirometer
Lung Volumes & Capacities Volumes
1. Tidal volume- volume of
air inhaled/exhaled
during quite breathing-
500 ml
2. Inspiratory reserve
volume- volume that can
be inhaled forcefully-2 L
3. Expiratory reserve
volume-volume that can
be exhaled forcefully- 1 L
4. Residual volume- that
remains in the lung even
after forceful expiration-
1.2 L
Capacities
Lung Volumes & 1. Vital capacity- maximum
amount or air that can be
Capacities expired or inspired forcefully.
(= TV + IRV + ERV)- 5 L
2. Inspiratory capacity-TV + IRV-
2.5 L
3. Expiratory capacity- TV + ERV-
1.5 L
4. Functional residual capacity-
Volume of air remaining in the
lung after quite expiration- RV
+ ERV- 2.5 L
5. Total lung capacity- VC + RV-
6.0 L
Tests for dynamic ventilatory functions
• FEV1 (timed vital
capacity)
• FEV1/FVC ratio
• Flow volume
relations
Forced expiration volumes
Restrictive and obstructive are 2 categories of
chronic lung conditions. In both shortness of
breath, cough, and reduced exercise tolerance.
Restrictive lung disease
Difficult to expand the lungs fully with air.
Difficulty in inhaling caused by stiff lungs, a stiff
chest wall, weak muscles, or damaged nerves.
Examples include interstitial lung disease,
sarcoidosis, obesity, scoliosis, and
neuromuscular diseases.
Obstructive lung disease
Hard to exhale all the air from lungs.
Symptoms worsen with exhalation
This is often caused by airway inflammation and
obstruction.
Examples include asthma, bronchiectasis,
chronic obstructive pulmonary disease (COPD),
and emphysema.
In restrictive diseases, inspiration
Flow Volume curve is limited by reduced compliance
of lung or chest wall, or weakness
of the inspiration muscles.
Example- Interstitial lung disease,
sarcoidosis, obesity, scoliosis, and
neuromuscular diseases
In obstructive disease, the total
lung capacity is typically
abnormally large, but expiration
ends prematurely either by
spasm of bronchial smooth
muscle as in asthma, or loss of
elastic recoil traction of alveoli as
in emphysema. Other causes
include pulmonary edema or
secretions within the airways.
Examples- Asthma,
bronchiectasis, COPD,
and emphysema.
Obstructive Disease—Asthma
• Asthma is characterized by episodic or chronic breathlessness, wheezing,
cough, and a feeling of tightness.
• Three airway abnormalities are present:
1. Airway obstruction due to spasm that is at least partially reversible,
2. Airway inflammation,
3. Airway hyperresponsiveness to a variety of stimuli.
• A link to allergy has long been recognized, and plasma IgE levels are elevated.
• Proteins released from eosinophils in the inflammatory reaction may damage
the airway epithelium and contribute to the hyperresponsiveness. –
eosinophilia.
• Leukotrienes are released from eosinophils and mast cells, and enhance
bronchoconstriction.
• Numerous other amines, neuropeptides, chemokines,and interleukins have
effects on bronchial smooth muscle or produce inflammation, and they may
be involved in asthma.
• Treatment- 2 agonists, steroids-suppress inflammation, Leukotine antagonist
Next class
We will continue with the
Pulmonary function tests
MV, Dead space, MVV
Thank you
